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Aim: To study whether an oat bran enriched diet has a specific effect in lowering total and low-density lipoprotein cholesterols, in addition to caloric and fat restriction. Methods: We performed a randomized, controlled, parallel-group, single-centre study in which 1,994 patients from the Wehrawald Hospital (Todtmoos, Germany) were screened and 235 met the criteria male gender, hypercholesterolemia, and overweight. All patients in the Wehrawald Hospital took part in a 4-week standardized inpatient lifestyle health program consisting of dietary intervention, increased physical activity, and health education. Caloric restriction, fat modification, and oat bran supplementation were part of the nutritional regimen within the lifestyle health program. Ninety-nine patients were randomized to a fat-modified diet with caloric restriction and a daily intake of 35–50 g oat bran and 136 patients to a fat-modified, oat bran-free diet with caloric restriction. Fifty-three male overweight but normocholesterolemic subjects were selected as controls. Results: The most significant decreases in total cholesterol (–67.7 ± 37.2 mg/dl; p < 0.01), low-density lipoprotein cholesterol (–56.3 ± 35.1 mg/dl; p < 0.01), and apolipoprotein B (–42.4 ± 34.1 mg/dl; p < 0.01) were found with the combination of the fat-modified and oat bran enriched food. Conclusions: Added to a fat-modified diet, oat bran within a practical range of intake significantly reduces total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. These beneficial effects occurred independent of covariables such as physical activity or caloric and fat restriction in the diet.

Herz-Kreislauf-Erkrankungen fuhren je nach Art und Schweregrad zu einer Verringerung der korperlichen Belastbarkeit. Hieraus konnen sich auch Einschrankungen im Beruf und dem sozialen Leben der Patienten ergeben. Daher ist ein wesentliches Ziel der Begutachtung, die korperliche Belastbarkeit moglichst umfassend und objektiv zu erfassen.

To study whether an oat bran enriched diet has a specific effect in lowering total and low-density lipoprotein cholesterols, in addition to caloric and fat restriction.We performed a randomized, controlled, parallel-group, single-centre study in which 1,994 patients from the Wehrawald Hospital (Todtmoos, Germany) were screened and 235 met the criteria male gender, hypercholesterolemia, and overweight. All patients in the Wehrawald Hospital took part in a 4-week standardized inpatient lifestyle health program consisting of dietary intervention, increased physical activity, and health education. Caloric restriction, fat modification, and oat bran supplementation were part of the nutritional regimen within the lifestyle health program. Ninety-nine patients were randomized to a fat-modified diet with caloric restriction and a daily intake of 35-50 g oat bran and 136 patients to a fat-modified, oat bran-free diet with caloric restriction. Fifty-three male overweight but normocholesterolemic subjects were selected as controls.The most significant decreases in total cholesterol (-67.7 +/- 37.2 mg/dl; p0.01), low-density lipoprotein cholesterol (-56.3 +/- 35.1 mg/dl; p0.01), and apolipoprotein B (-42.4 +/- 34.1 mg/dl; p0.01) were found with the combination of the fat-modified and oat bran enriched food.Added to a fat-modified diet, oat bran within a practical range of intake significantly reduces total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. These beneficial effects occurred independent of covariables such as physical activity or caloric and fat restriction in the diet.

Ein ubergewichtiger, alleinstehender, 55-jahriger Patient stellt sich bei Ihnen in der Sprechstunde zur Kontrolluntersuchung vor. Trotz Dreifachkombination finden sich in seinem Blutdruck-Tagebuch nur Werte deutlich uber 140/90 mmHg. Wie klaren Sie ab, ob bei ihm eine schwer einstellbare Hypertonie vorliegt?

Im Verlauf der arteriellen Hypertonie kommt es zu typischen funktionellen und strukturellen Veranderungen des linken Ventrikels und der Koronargefase [15, 37, 71, 74, 139, 141, 215, 223, 225], die unabhangig voneinander zu einer gestorten Pumpfunktion zunachst in Ruhe, dann bei Belastung und im Spatstadium auch zu einem Pumpversagen des Herzens fuhren konnen (Abb. 46).

Aufgrund der grosen prognostischen Bedeutung ist eine rechtzeitige und exakte Erfassung der linksventrikularen Hypertrophie Hochdruckkranker von groser klinischer Bedeutung. In einer knappen Ubersicht stellt die Tabelle 1 die diagnostischen Moglichkeiten zur Beurteilung einer Linksherzhypertrophie Hochdruckkranker dar, wobei allerdings den verschiedenen Untersuchungsverfahren eine deutlich unterschiedliche Wertigkeit zukommt. Nach Einfuhrung der Echokardiographie wurde schnell erkannt, das eine fruhzeitige und exakte Beurteilung einer linksventrikularen Hypertrophie mit Hilfe des Elektrokardiogramms bzw. des Rontgenthoraxbildes nur sehr eingeschrankt moglich war. Nach Untersuchungen von Levy et al. [134] und Savage et al. [199] haben nur 10% der Patienten mit einer echokardiographisch nachgewiesenen linksventrikularen Hypertrophie auch diesbezugliche richtungsweisende EKG-Kriterien. Auf der anderen Seite wiesen mehr als 40%, die im EKG Hinweise fur eine linksventrikulare Hypertrophie zeigten, einen normalen echokardiographisch bestimmten linksventrikularen Muskelmassenindex auf. Somit ist es nicht uberraschend, das die mit Hilfe der Echokardiographie erhobenen Daten eine weitaus grosere Praevalenz der linksventrikularen Hypertrophie bei Hypertonikern im Vergleich zu den Elektrokardiographie-Kriterien ergab [134]. Die gleichen Einschrankungen sind auch fur die Ront-genthoraxaufnahme gultig.

The blood pressure behavior during and after ergometric exercise was investigated in 552 males in order to clarify if this standardized procedure is suitable for differentiating between normotensive subjects and hypertensive patients. Patients suffering from mild hypertension showed significantly (p less than 0.001) higher blood pressures (213 +/- 22/116 +/- 11 mm Hg) at 100 W and after loading than age-matched normotensives (188 +/- 14/92 +/- 9 mm Hg) but significantly (p less than 0.001) lower values than hypertensives with stable hypertension (225 +/- 22/126 +/- 11 mm Hg). Moreover, the systolic pressure response to ergometric work was significantly (p less than 0.05--p less than 0.01) influenced by age. Using the normal upper limits for blood pressure during and after ergometry the ergometric procedure revealed that 50% of the patients with borderline hypertension at rest could be classified as hypertensives. Their blood pressure response at 100 W (216 +/- 21/113 +/- 8 mm Hg) did not significantly differ from the patients with mild hypertension. In contrast, in the 50% who reacted negatively to ergometric testing, the systolic blood pressure response at 100 W (204 +/- 18 mm Hg) was significantly (p less than 0.01) lower than that of those who demonstrated a positive reaction, revealing exactly the same diastolic blood pressure value of 92 mm Hg as the normotensives. The present study strongly suggests that the assessment of blood pressure during ergometric testing is quite useful in distinguishing between normotensive and hypertensive patients and in making estimates of blood pressure response to daily stress more accurate.